Through the mouth? New surgeries promise faster recovery, fewer scars

Bower

GREENVILLE, N.C.
(Oct. 1, 2008)
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When Cheryl Taylor needed a common follow-up procedure to her gastric-bypass surgery, she learned about a new procedure that would not involve cutting through her skin.

Instead, surgeons would operate on her stomach through her mouth.

"I thought, 'Well, if it works, it will be great,'" she said. "I was cut open with the first procedure, and it was tough."

Taylor's operation went smoothly, and she returned home to Goldsboro the same evening.

"Easiest way to go," she said. "I'm very pleased with it. I'm glad I did it."

Called natural-orifice surgery, it's one of three new techniques East Carolina University surgeons are offering that promise less scarring and faster, easier recovery for common surgeries such as gall bladder removal. Surgeons operate through the mouth or other body opening. Dr. Curtis Bower, a clinical assistant professor of surgery, performed Taylor's operation.

"Potential advantages of natural orifice surgery may include decreased pain or even painless surgery, improved cosmetic results from having no incisions made on the body, and faster recovery and return to work," Bower said. As technology improves, he added, so will the potential for this type of surgery.

Another technique is called single-incision laparoscopic surgery. In traditional laparoscopic surgery, surgeons make multiple small incisions to insert surgical devices and cameras to allow them to see what they were doing. As the name implies, SILS reduces the number of incisions to one, often the navel, which further camouflages the scar. New instruments and techniques allow surgeons to insert and manipulate the tools through the same opening.

Dr. William Rucker, an ECU clinical assistant professor who operates at Lenoir Memorial Hospital in Kinston, said patients' desires for less scarring as well as surgical advances led to SILS. He began doing the procedures in June. Many people prefer one scar in the belly-button area over multiple scars on their abdomen, and the smaller, more versatile tools surgeons have today make these surgeries possible, he said.

Bower also began offering this procedure recently. "I am very excited about this advancement of laparoscopic surgery," he said. "We are taking a very common procedure and making it virtually scar-free. I had a patient come back to see me recently and neither of us could find her scar."

Bower wants to expand this technique into other procedures such as hernia repairs. "This is very exciting to be a part of this next wave of minimally invasive surgery," he said.

A third minimally invasive technique is video-assisted thyroidectomy for patients who have certain types of thyroid nodules. By using an incision of less than an inch and a video camera, surgeons can remove part or all of the thyroid with minimal scarring. Many patients can go home the same day.

"The main challenge is working in a small area with the camera, a retractor and several instruments," said Dr. Walter Pofahl, an associate professor and chief of advanced laparoscopic, gastrointestinal and endocrine surgery at ECU. "The incision and anatomy are the same as conventional thyroid surgery."